Monoethylglicinexylidide test: A prognostic indicator of survival in cirrhosis

Abstract

The aim of this study was to assess the value of the monoethylglicinexylidide assay, a dynamic liver function test based on the determination of the serum concentration of lidocaine major metabolite, as a predictor of survival in cirrhosis. For this purpose, the predictive value of monoethylglicinexylidide was evaluated in comparison with the Pugh score, ascites, encephalopathy and a number of different biochemical parameters as collected from the prospective follow-up of 118 patients with cirrhosis. A stepwise regression analysis was performed on the variables of prognostic value according to the Cox model and with respect to 1-yr survival; because Pugh score and monoethylglicinexylidide were the sole variables selected, they were proved to supply independent prognostic information. The most reliable cutoff values for discrimination between death and survival were 25 ng/ml or less for monoethylglicinexylidide and less than 9 for the Pugh score. In 74 patients without overt signs of liver failure (i.e., Pugh < or = 9), monoethylglicinexylidide provided a wide range of results (i.e., 4 to 77 ng/ml), namely values ranging from very low to elevated. Of the 38 patients with satisfactory Pugh scores (< or = 9) but poor monoethylglicinexylidide values (< or = 25), 11 died during follow-up and 3 underwent liver transplantation, despite having shown no clinical signs of liver failure at entry. On the bases of discriminant levels, the monoethylglicinexylidide test is suitable for adoption as a reliable and sensitive indicator of survival in patients with cirrhosis because it supplies more accurate prognostic information compared with the Pugh score.(ABSTRACT TRUNCATED AT 250 WORDS)

MELD and PELD: Application of survival models to liver allocation

“…[21][22][23]27,28 Many of these models excluded patients with decompensated cirrhosis 22,23,29 and many used quantitative measures of hepatic function such as aminopyrine breath test, galactose elimina-tion capacity, and monoethylglycinexylidide test, studies which are currently not uniformly performed nor provide incremental prognostic information. 9,[30][31][32][33][34][35] Other models utilize variables such as plasma levels of norepinephrine, pseudocholinesterase, and renin, laboratory tests which are usually not readily available at most institutions and frequently are determined using local assays, which may not be comparable. 36,37 Still other models used subjective variables such as cognitive dysfunction, degree of encephalopathy, nutritional status, degree of ascites, and hepatorenal syndrome, all of which are poorly defined and open to wide range of interpretations.…”

Potential use of metabolic breath tests to assess liver disease and prognosis: has the time arrived for routine use in the clinic?

“…47 Moreover, the MEGX test predicts survival in patients with cirrhosis more accurately than the CTP score. 48,49 MEGX has been suggested to complement the CTP score in patients undergoing evaluation for liver transplantation. 49 Preoperative MEGX has also proved useful in estimating liver reserve in non-cirrhotic patients prior to liver resection to identify patients at high risk of developing postoperative liver failure.…”

A fourth dimension in decision making in hepatology

“…This approach can provide more accurate prognostic information than the CTP score. 9,10 Breath tests have been used for several decades in patients with both acute and chronic liver disorders. [11][12][13] These tests are based on measuring the exhaled metabolites of labeled substrates that are ingested by the patient and metabolized by the liver.…”